FPPA Statewide Death & Disability Plan Forms

For Members During Their Career

Step by Step Through the Disability Process

Apply for a Disability Benefit

For Member Survivors

Apply for a Survivor Benefit

For Members Currently Receiving Benefits

Change in Disability Status Application

Request SRA Distribution from FPPA - For the disability or survivor benefits applicable to your situation.
- Instructions
- Special Tax Notice
- Application

Currently receiving Disability Benefits and are now divorcing.

Disability Retiree Change of Designated Beneficiary

FPPA Forms for the Management of Deposits

Electronic Funds Transfer (EFT) Form

Deposit Advice Selection Form - Control the frequency of your Deposit Advices with this form. Learn more about Deposit Advices options.

Affidavit For Check Replacement

W-4P Monthly Pension Distribution Form

W-9 Request for Taxpayer Identification Number and Certification




National Suicide Prevention Lifeline
Are you in a crisis? Struggling emotionally and need to talk to someone?

Call the National Suicide Prevention Lifeline or chat online.
It's free and confidential.

(800) 273-TALK (8255)  •  suicidepreventionlifeline.org